Provider Demographics
NPI:1609169713
Name:THE CAMELLIA FOUNDATION
Entity Type:Organization
Organization Name:THE CAMELLIA FOUNDATION
Other - Org Name:CLINICA CAMELLIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAMELLIA
Authorized Official - Middle Name:
Authorized Official - Last Name:RODNEY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:901-753-0423
Mailing Address - Street 1:3030 COVINGTON PIKE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38128-5048
Mailing Address - Country:US
Mailing Address - Phone:901-432-5727
Mailing Address - Fax:901-384-6309
Practice Address - Street 1:3030 COVINGTON PIKE
Practice Address - Street 2:SUITE 200
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38128-5048
Practice Address - Country:US
Practice Address - Phone:901-432-5727
Practice Address - Fax:901-384-6309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-23
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN13931207Q00000X
TN40403207V00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty